The Mental Health Consequences of Disaster-Related Loss: Findings from Primary Care One Year After the 9/11 Terrorist Attacks

This study examines the long-term psychiatric consequences, pain interference in daily activities, work loss, and functional impairment associated with 9/11-related loss among low-income, minority primary care patients in New York City. A systematic sample of 929 adult patients completed a survey that included a sociodemographic questionnaire, the PTSD Checklist, the PRIME-MD Patient Health Questionnaire, and the Medical Outcomes Study Short Form-12 (SF-12). Approximately one-quarter of the sample reported knowing someone who was killed in the attacks of 9/11, and these patients were sociodemographically similar to the rest of the sample. Compared to patients who had not experienced 9/11-related loss, patients who experienced loss were roughly twice as likely (OR = 1.97, 95%; CI = 1.40, 2.77) to screen positive for at least one mental disorder, including major depressive disorder (MDD; 29.2%), generalized anxiety disorder (GAD; 19.4%), and posttraumatic stress disorder (PTSD; 17.1%). After controlling for pre-9/11 trauma, 9/11-related loss was significantly related to extreme pain interference, work loss, and functional impairment. The results suggest that disaster-related mental health care in this clinical population should emphasize evidence-based treatments for mood and anxiety disorders.

[1]  T. Heir,et al.  Psychiatric disorders among disaster bereaved: an interview study of individuals directly or not directly exposed to the 2004 tsunami , 2009, Depression and anxiety.

[2]  Avi Besser,et al.  PTSD symptoms, satisfaction with life, and prejudicial attitudes toward the adversary among Israeli civilians exposed to ongoing missile attacks. , 2009, Journal of traumatic stress.

[3]  Daeho Kim,et al.  Psychometric Properties of the Life Events Checklist-Korean Version , 2008, Psychiatry investigation.

[4]  R. Hirschfeld.  Screening for bipolar disorder. , 2007, The American journal of managed care.

[5]  S. Maguen,et al.  Prevalence and psychological correlates of complicated grief among bereaved adults 2.5-3.5 years after September 11th attacks. , 2007, Journal of traumatic stress.

[6]  Amar K. Das,et al.  Posttraumatic stress disorder in primary care one year after the 9/11 attacks. , 2006, General hospital psychiatry.

[7]  P. Mortensen,et al.  Hospitalization for mental illness among parents after the death of a child. , 2005, The New England journal of medicine.

[8]  Amar K. Das,et al.  Screening for bipolar disorder in a primary care practice. , 2005, JAMA.

[9]  J. Elhai,et al.  Health Service Use Predictors Among Trauma Survivors: A Critical Review , 2005 .

[10]  Amy E. Latham,et al.  Suicidality and bereavement: complicated grief as psychiatric disorder presenting greatest risk for suicidality. , 2004, Suicide & life-threatening behavior.

[11]  Brett T. Litz,et al.  Psychometric Properties of the Life Events Checklist , 2004, Assessment.

[12]  H. Prigerson,et al.  A case for establishing complicated grief as a distinct mental disorder in DSM-V. , 2004, Clinical psychology review.

[13]  Y. Neria,et al.  BEREAVEMENT BY TRAUMATIC MEANS: THE COMPLEX SYNERGY OF TRAUMA AND GRIEF , 2004, Journal of loss & trauma.

[14]  P. Stang,et al.  Impact of Pain on Depression Treatment Response in Primary Care , 2004, Psychosomatic medicine.

[15]  G. Klerman,et al.  Assessing impairment in patients with panic disorder: the Sheehan Disability Scale , 1992, Social Psychiatry and Psychiatric Epidemiology.

[16]  Bonnie L. Green,et al.  Trauma and health : physical health consequences of exposure to extreme stress , 2004 .

[17]  C. Kuo,et al.  Prevalence of psychiatric disorders among bereaved survivors of a disastrous earthquake in taiwan. , 2003, Psychiatric services.

[18]  P. Mortensen,et al.  Mortality in parents after death of a child in Denmark: a nationwide follow-up study , 2003, The Lancet.

[19]  Virginia Gil-Rivas,et al.  Nationwide longitudinal study of psychological responses to September 11. , 2002, JAMA.

[20]  Lisa Thalji,et al.  Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11. , 2002, JAMA.

[21]  S. Galea,et al.  Psychological sequelae of the September 11 terrorist attacks in New York City. , 2002, The New England journal of medicine.

[22]  Sheri L. Johnson,et al.  Screening for bipolar disorder. , 2002, Psychiatric services.

[23]  D. R. Lehman,et al.  Resilience to loss and chronic grief: a prospective study from preloss to 18-months postloss. , 2002, Journal of personality and social psychology.

[24]  M. Stein,et al.  Reported trauma, post-traumatic stress disorder and major depression among primary care patients , 2001, Psychological Medicine.

[25]  D. Forbes,et al.  The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD. , 2001, Behaviour research and therapy.

[26]  Debby E. Doughty,et al.  Traumatic Grief in a Convenience Sample of Victims Seeking Support Services After a Terrorist Incident , 2001, Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists.

[27]  R. Spitzer,et al.  Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. , 1999, JAMA.

[28]  A. Beck,et al.  Posttraumatic stress disorder in primary care. , 1999, The Journal of family practice.

[29]  H. Merskey,et al.  The prevalence of current major depression and dysthymia in a Norwegian general practice , 1997, Acta psychiatrica Scandinavica.

[30]  M K Shear,et al.  Traumatic grief as a risk factor for mental and physical morbidity. , 1997, The American journal of psychiatry.

[31]  C. Reynolds,et al.  Complicated grief as a disorder distinct from bereavement-related depression and anxiety: a replication study. , 1996, The American journal of psychiatry.

[32]  M. Olfson,et al.  Subthreshold psychiatric symptoms in a primary care group practice. , 1996, Archives of general psychiatry.

[33]  J. Vessey,et al.  Patterns of mental health service utilization. , 1996, Archives of general psychiatry.

[34]  E. Blanchard,et al.  Psychometric properties of the PTSD Checklist (PCL). , 1996, Behaviour research and therapy.

[35]  Sati Mazumdar,et al.  Social rhythm stability following late-life spousal bereavement: associations with depression and sleep impairment , 1996, Psychiatry Research.

[36]  J. Ware,et al.  A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. , 1996, Medical care.

[37]  T. Glass,et al.  The effects of negative life events on alcohol consumption among older men and women. , 1995, The journals of gerontology. Series B, Psychological sciences and social sciences.

[38]  E. Rynearson,et al.  Bereavement after homicide: a synergism of trauma and loss. , 1993, The American journal of psychiatry.

[39]  P. Leaf,et al.  Poverty and psychiatric status. Longitudinal evidence from the New Haven Epidemiologic Catchment Area study. , 1991, Archives of general psychiatry.

[40]  P. Leaf,et al.  Depressive episodes and dysphoria resulting from conjugal bereavement in a prospective community sample. , 1990, The American journal of psychiatry.

[41]  M. Weissman,et al.  Factors Affecting the Utilization of Specialty and General Medical Mental Health Services , 1988, Medical care.